The impact of day care on ventilation tube insertion

Objective: To study the effect of day care and tube type, as well as other risk factors related to ventilation tube insertion and reinsertion. Design: A case series of 456 consecutive cases with 162 controls from a well-baby examination group evaluated for age, sex, smoking history and day care attendance. Setting: Private practice in a mid-sized, southeastern university town. Patients and controls: This was a referred sample of patients who were entered consecutively in a private-practice setting. All children were ape five or less at entry into the study. Interventions: Children underwent ventilation tube insertion with or without adenoidectomy, using standing indications. Main outcome measures: The primary outcome measures were whether or not a child had the need for a second set of tubes, and also determining the status of the child's ears for at least 1 year after tubes had extruded. Results: Day care and younger age were both identified as risk factors associated with initial ventilation tube insertion. Only 11%(seven out of 63) of home care children, as compared with 31% (108 out of 346) day care children, had the insertion of ventilation tubes (P = 0.000). Day care children who had tubes inserted and adenoidectomy (with or without tonsillectomy) had a significantly lower rate of reintubation than children who had tube insertion alone (P = 0.00). Day care and young age are significant risk factors for any child, both with a first set of tubes and for ventilation tube reinsertion. Children in day care had a reintubation rate of 36% as compared to 11% for those in home care. Parents should be aware that day care can represent a two-fold hazard both in the observed connection between day care and tube insertion and the demonstrated increased probability of reinsertion. Any studies looking at ventilation tube outcomes need to make certain to monitor for day care attendance. (C) 1997 Elsevier Science Ireland Ltd.